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Biomedical subjects

R West

Publications and source records attributed to R West.

At least 73 records · Page 4Linked to original sources
PubMed2001

Smoking cessation activities by general practitioners and practice nurses.

OBJECTIVES: To assess general practitioners' and practice nurses' self reported behaviour, attitudes, and knowledge in relation to smoking cessation. DESIGN AND SETTING: Two postal surveys of random national samples of 303 GPs (survey 1) and 459 practice nurses (survey 2) covering England and Wales; effective response rates were 75% and 96%, respectively. RESULTS: Survey 1 found that 96% of GPs accepted that intervening against smoking was part of their role and almost all (99%) said that they recorded smoking status when patients registered; 57% reported that they routinely updated their records on smoking status, 50% said they advised smokers to stop during most or all consultations, and 76% said they advised smokers to cut down if they cannot stop. A large majority (83%) said they either recommended or prescribed nicotine replacement therapy (NRT). Although most GPs (86%) thought that NRTs were effective, only a minority thought they were worth the cost (47%) or should be on National Health Service (NHS) prescription (32%). There was little evidence that previous training in smoking cessation was associated with more activity, more positive attitudes, or greater knowledge. Survey 2 found that almost all practice nurses (99%) agreed that intervening against smoking was part of their role and 95% said they advised patients to stop at least occasionally; 71% said they advised smokers to stop at most or all consultations. A majority (74%) said that they recommended NRT to their patients. As with the GPs most practice nurses thought that nicotine replacement was effective (79%), but fewer (42%) thought the cost was justified, and only about half (53%) thought it should be available on NHS prescription. Nurses who said they had been trained in smoking cessation engaged in more activity relating to smoking cessation, had more positive attitudes, and were more knowledgeable. CONCLUSION: GPs and practice nurses accepted that intervening with smoking was an important part of their role and a large majority reported that they intervened at least with some smokers. This represents a promising baseline from which to proceed in terms of implementation of the new smoking cessation guidelines, but it is hoped that improvements can be made in terms of the frequency of updating records and intervening, and acceptance of the cost-effectiveness of NRT as a life preserving intervention.

Adult↗
PubMed2001

Glucose for smoking cessation: does it have a role?

Nicotine replacement therapies and amfebutamone (bupropion) have both been shown to aid smoking cessation. However, even with the best support most attempts to stop smoking fail, and many smokers prefer not to use medications in their quit attempts. Oral dextrose (glucose) has been proposed as a possible aid to smoking cessation which would be very inexpensive and might be used by some smokers as well as or instead of medications. It is hypothesised that single doses of nicotine relieve hunger in smokers so that over time smokers therefore come, in certain situations, to interpret sensations associated with hunger as craving for a cigarette. Adaptation to long term nicotine intake leads to exacerbation of these sensations during periods of abstinence. Chewing dextrose tablets results in a rapid increase in blood glucose levels that would be expected to yield a small reduction in these sensations which might then translate into a reduction in craving. An intervention that reduced craving might help smokers to maintain abstinence. Placebo-controlled studies have provided some support for the hypothesis that chewing glucose tablets can reduce desire to smoke during abstinence, and the one adequately powered study carried out so far found that glucose tablets increased 1-month abstinence rates significantly compared with a placebo. Definitive trials are now required but, given their low cost, glucose tablets may be a useful aid for some smokers.

Glucose↗
PubMed2001

Objective standards for the emergency services: emergency admission to hospital.

The primary objectives of the emergency services are to minimize early mortality and complications, although longer-term morbidity, quality of life and late mortality may also be influenced by early actions. Evaluation of the emergency services and demonstration of quality need to reflect these objectives by appropriate choice of outcome measures. This brief review of leading measures of quality in emergency admissions discusses population-based 30-day mortality, after examining some limitations of 'hospital mortality', incidences of complications, which can be more sensitive measures of quality of care when mortality rates are low, and a role for audit and management, when relationships between process and outcome are clear. As an example, the UK study of urgent admission to hospital, on behalf of the Clinical Standards Advisory Group, showed wide variation between sampled hospitals in timeliness of early clinical actions and a statistically significant association between timeliness and 30-day survival. The review also discusses capacity, a necessary requirement for a quality service, and operations research/queuing theory to facilitate management of capacity/resources to meet fluctuating demands. The NHS should be able to plan for seasonal needs.

Emergency Service, Hospital↗
PubMed2001

Influences on the efficiency of prospective memory in younger and older adults.

The influence of 4 factors on age-related declines in prospective memory (PM) was considered in 2 experiments. The results of the experiments reveal that age-related differences in PM were not moderated by the degree of match between the nature of processing required in the ongoing activity and the defining features of the PM cue. Age-related differences in the accuracy of PM responses were primarily attributable to an increase in the number of omission errors committed by older adults. Age-related differences in PM were somewhat independent of the ability to recall the PM cues and intentions following task performance and were mediated by the cognitive resources of processing speed, inhibitory control, and working memory.

Adult↗
PubMed2000

Effects of task context and fluctuations of attention on neural activity supporting performance of the stroop task.

The influence of task context and transient fluctuations in attentional control on neural processes supporting performance of the Stroop task was investigated using event-related brain potentials. Task context was manipulated by varying the proportion of congruent and incongruent trials across different blocks of trials, and fluctuations of attentional control were considered by examining differences between trials eliciting faster and slower responses. The amplitudes of the N450, thought to reflect the suppression of a conceptual level processing system, and a temporo-parietal slow wave, thought to index the processing of color information, were greater when trials were mostly congruent in comparison to when trials were mostly incongruent. These findings indicate that the neural systems supporting inhibition and color processing are modulated by task demands. For the N450 the effect of task context interacted with the efficiency of attentional control being present for those trials eliciting faster responses and not for those trials eliciting slower responses. This finding is consistent with those from a growing number of studies indicating that the neural systems supporting attentional control are transient in nature, tending to fluctuate in efficiency over time.

Adult↗
PubMed2000

Exercise interventions for smoking cessation.

BACKGROUND: Taking exercise may help people give up smoking by moderating the effects of nicotine withdrawal. OBJECTIVES: To determine whether exercise-based interventions combined with a smoking cessation programme are more effective than a smoking cessation intervention alone. SEARCH STRATEGY: We searched The Cochrane Tobacco Addiction group specialised register for studies including the terms 'exercise' or 'physical activity' in February 2000. SELECTION CRITERIA: We included randomised trials comparing an exercise programme as an adjunct to a cessation programme with a cessation programme alone, recruiting smokers or recent quitters, and with a follow-up of 6 months or more. DATA COLLECTION AND ANALYSIS: We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarised the results narratively, making no attempt at meta-analysis. MAIN RESULTS: We identified eight trials, six of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Only one trial showed a significant benefit from the exercise programme at long term follow-up. REVIEWER'S CONCLUSIONS: Only one of the eight trials offered evidence for exercise aiding smoking cessation but the other trials were too small to exclude reliably an effect of intervention. Trials are needed with larger sample sizes, equal contact control conditions, tailored and lifestyle exercise programmes and measures of exercise adherence.

Exercise↗
PubMed2000

A comparison of the abuse liability and dependence potential of nicotine patch, gum, spray and inhaler.

RATIONALE: Nicotine replacement therapy (NRT) in varying forms is becoming widely used. Clinicians, therapists and regulatory authorities are interested in the abuse liability and dependence potential of the different forms. OBJECTIVES: To compare the abuse liability and dependence potential of nicotine gum, transdermal patch, spray and inhaler. METHODS: 504 male and female smokers seeking help with stopping smoking were randomly allocated to the four products. Measures were taken at the designated quit date, then 1 week, 4 weeks, 12 weeks and 15 weeks later. Smokers were advised to use the product for up to 12 weeks. Those still using the product at the 12-week visit were advised to cease use by week 14. Measures included: pleasantness and satisfaction ratings at weeks 1 and 4 (used as a marker of abuse liability); ratings of feeling dependent on NRT at weeks 1, 4, 12 and 15 (used as a marker of subjective dependence); mood and physical symptoms ratings at weeks 12 and 15 (the change being used to assess physical dependence on NRT), continued usage of NRT at week 15 (used as an marker of behavioural dependence). RESULTS: Average ratings of pleasantness were low. The nicotine patch was rated as less unpleasant to use than all other products. There were no significant differences between the products in terms of satisfaction or subjective dependence except at week 15 when no patch users rated themselves as dependent. Continued use of NRT at week 15 was related to rate of delivery of nicotine from the products - 2% for patch, 7% for gum and inhaler, 10% for spray (P<0.05 for linear association). Among those

Adult↗
PubMed2000

Recurrence of non-Hodgkin's lymphoma isolated to the right masticator and left psoas muscles.

We present the clinical and magnetic resonance imaging findings of a patient who, following treatment for pancreatic non-Hodgkin's lymphoma (NHL), relapsed with apparently isolated involvement of the right masticator space and left psoas muscles. Non-Hodgkin's lymphoma arising from the masticator space muscles is very rare. In addition, simultaneous lymphomatous involvement of multiple discrete skeletal muscle sites, in the absence of disease elsewhere, has previously only been reported in the limb or limb girdle muscles. Lymphoma should be considered as a cause of isolated enlarged skeletal muscles, even when involving such distant sites.

Female↗
PubMed2000

Symptom attribution and the recognition of psychiatric morbidity.

OBJECTIVE: Patients' interpretation of ambiguous physical symptoms may influence illness presentation in primary care. The present study sought to investigate the influence of symptom attribution style on the recognition of psychiatric morbidity by general practitioners (GPs). METHODS: Patients consulting GPs completed assessments of attribution style and General Health Questionnaires (GHQs), while GPs provided independent ratings of psychiatric distress. Analysis examined the relationship between patient demographic variables, attribution style (using the Symptom Interpretation Questionnaire [SIQ]), and GP and GHQ assessments of patients' mental health. RESULTS: The results indicate that severity of disorder and patient age were reliable predictors of recognition: normalizing and psychological attributions were additional predictors in some analyses, but their effects were inconsistent. CONCLUSIONS: The results provide some support for the role of symptom attribution in the recognition of psychiatric morbidity, but suggest that the predictive value of such attributions may be relatively modest. The SIQ may not be the optimum instrument for the measurement of attributions.

Adolescent↗
PubMed2000

Conformations of linear chains. Systematics and suggestions for nomenclature.

There are six categories of calculated favored dihedral angles in linear M(n)X(2n+2) chains. The Prelog-Klyne nomenclature is not helpful for classifying them, and we propose the following labels and symbols: A, anti, reserved for torsional angles within a few degrees of 180 degrees; T, transoid, omega approximately 165 degrees; D, deviant, omega approximately 150 degrees; O, ortho, omega approximately 90 degrees; G, gauche, omega approximately 60 degrees; C, cisoid, omega approximately 40 degrees. With the exception of C, all of these categories have been observed in alkanes, perfluoroalkanes, or oligosilanes.

Molecular Conformation↗
PubMed2000

Stable silylenes.

The field of stable silylene research has grown dramatically since the first isolation of a stable silylene in 1994. Prior to 1994, silylenes existed only as reactive intermediates, isolable only in low-temperature matrixes. Since then, several stable silylenes have been synthesized, some in fact showing remarkable thermal stability. This Account highlights the developments in stable silylene chemistry, including theoretical and experimental studies attempting to explain the remarkable stability of the silylenes as well as the rapidly expanding reaction chemistry of the stable silylenes.

Molecular Structure↗